Synchronous diffuse large B-cell lymphoma of the small intestine and adenocarcinoma of the colon

No abstract available.

A Case of Continuous Positive Airway Pressure Therapy in a Patient with Central Sleep Apnea and Heart Failure / 수면정신생리

Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

Obstructive Sleep Apnea in Interstitial Lung Disease / 수면정신생리

Obstructive sleep apnea is a common disorder in which respiratory flow decreases or disappears despite respiratory effort due to occlusion of the upper respiratory tract during sleep. Oxidative stress and systemic inflammatory reaction induced by the obstruction cause complications such as hypertension, coronary artery disease, and diabetes and increase cancer incidence. Furthermore, in patients with interstitial lung disease, obstructive sleep apnea has a very high prevalence and is thought to have a close pathophysiological and clinical correlation. In other words, obstructive sleep apnea could be the cause or a complication of interstitial lung disease ; when these two afflictions coexist, the prognosis of the patient is worse. In patients with interstitial lung disease with obstructive sleep apnea, CPAP treatment significantly improved sleep and quality of life, as well as improved morbidity and mortality in a recent study. Therefore, early diagnosis and treatment of obstructive sleep apnea in patients with interstitial lung disease are very important, and additional studies designed to include patients with idiopathic pulmonary fibrosis as well as patients with advanced interstitial lung disease should be performed.

Two Cases of Allergy to Insulin in Gestational Diabetes

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Necessity for a National Carcinogen List in Korea, Based on International Harmonization

Cancer has been the leading cause of death in Korea for the last 30 years. Cancer patients' 5-year survival rate between 2005 and 2009 was 62.0%, representing a highly advanced standard of care, as much as developed countries in the EU and the US. The Korean government formulated its first 10-year plan for cancer control in 1996 and has been carrying out a second 10-year plan for cancer control since 2006. But despite the Korean government's efforts, the cancer burden in Korea continues to increase. Many separate laws have gone into effect concerning the management of carcinogen exposure. However, there are no integrated regulatory laws or management systems against carcinogen exposure in Korea. Dead zones remain where carcinogen exposure cannot be controlled properly in Korea. In this paper, we suggest the need to establish a national carcinogen list based on international harmonization as a prerequisite for a paradigm shift in cancer control policy from treatment to primary prevention.

Corrigendum: Necessity for a National Carcinogen List in Korea, Based on International Harmonization

This article was initially published on the Environmental Health and Toxicology 2013;28:e2013008, with a misspelled name of the 7th coauthor.

Vaporization and Conversion of Ethanolamines used in Metalworking Operations

OBJECTIVES: This study examined how ethanolamines (EAs) with the same functional alcohol group (HOCH2CH2), such as mono-EA (MEA), di-EA (DEA), and tri-EA (TEA), in water-based metalworking fluids (wbMWFs) are vaporized, condensed, and transformed by heat generated during metalworking. METHODS: Two types of experimental apparatus were manufactured to achieve these objectives. RESULTS: Vaporization tests using a water bath showed that the vaporization rate increased markedly from 0.19 mg/m2.min at 23.5degrees C to 8.04 mg/m2.min at 60degrees C. Chamber tests with a heat bulb revealed that "spiked" MEA was fully recovered, while only 13.32% of DEA and no TEA were recovered. Interestingly, non-spiked types of EAs were detected, indicating that heat could convert EAs with more alcohol groups (TEA or DEA) into other EAs with fewer group(s) (DEA or MEA). The EA composition in fresh fluid was 4% DEA, 66% TEA, and 30% MEA, and in used fluids (n = 5) was 12.4% DEA, 68% TEA, and 23% MEA. Conversion from TEA into DEA may therefore contribute to the DEA increment. Airborne TEA was not detected in 13 samples taken from the central coolant system and near a conveyor belt where no machining work was performed. The DEA concentration was 0.45 mg/m3 in the only two samples from those locations. In contrast, airborne MEA was found in all samples (n = 53) regardless of the operation type. CONCLUSION: MEAs easily evaporated even when MWFs were applied, cleaned, refilled, and when they were in fluid storage tanks without any metalworking being performed. The conversion of TEA to DEA and MEA was found in the machining operations.